Open AccessDIFFERENTIATED SELECTION OF PORTAL VEIN PUNCTION POINT DURING TIPS IN COMBINATION WITH POSTOPERATIVE AUTOGEMOMAGNETOTHERAPY
Author(s) -
Mahiliavets E.V.,
Vasilchuk L.F.,
Yakubcevich R.E.,
Nevgen L.N.
Publication year - 2021
Publication title -
military medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.442
H-Index - 67
ISSN - 0026-4075
DOI - 10.51922/2074-5044.2021.4.73
Subject(s) - medicine , transjugular intrahepatic portosystemic shunt , hepatic encephalopathy , portal hypertension , portosystemic shunt , surgery , portal vein thrombosis , portal vein , shunting , radiology , shunt (medical) , vein , complication , cirrhosis
Topicality. The transjugular intrahepatic portosystemic shunt (TIPS) is widely used in the treatment of portal hypertension. However, this procedure has several major potential complications, which include hepatic encephalopathy as well as shunt dysfunction. In this connection, the development of TIPS modifications aimed at reducing the incidence of complications after this procedure seems relevant. Purpose of the study. To study the results of a modified portal vein puncture method, depending on its variant anatomy, as well as the combined use of autohemomagnetotherapy to prevent shunt thrombosis and progression of hepatic encephalopathy during TIPS. Materials and methods. In the course of a prospective randomized controlled study in the period from 2014 to 2020, the results of treatment of 37 patients were studied. Modification of the standard TIPS procedure was performed in the main group of patients: the choice of the optimal puncture point of the portal vein was carried out on the basis of the anatomical variant of the divergence of the right anterior branch of the failures and complications. Autohemomagnetotherapy was performed in the same group after performing transjugular intrahepatic portosystemic shunting daily for 5 days. Results and discussion. It was noted that the anatomical variant of the portal vein structure affects the success of TIPS (the correlation coefficient of the variant anatomical type of portal vein branching and the occurrence of technical difficulties in the group of the standard TIPS technique R = 0.81, p = 0.3). The proposed method of puncture of the portal vein is quite effective for the prevention of this complication. When using the modified TIPS, significantly less progression of hepatic encephalopathy was noted compared to the standard technique. The proposed method allows for the prevention of early thrombosis of shunts and recurrent bleeding from varicose veins of the esophagus and stomach. Conclusions. The proposed modified method of transjugular portosystemic shunting is effective, available and can be widely used in clinical practice.